Association Between the Commercial Characteristics of Psychotropic Drugs and Their Off-label Use

Graziul, Christopher; Gibbons, Robert V.; Alexander, G. Caleb

doi:10.1097/mlr.0b013e31826ec272

Cited by 9 publications

(2 citation statements)

References 22 publications

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“…Our overall rate of off-label use of antipsychotics (63.2%) was consistent with the finding in the US (60.7%) by Graziul.et al [ 18 ]. Our rates of off-label use in specific diagnostic categories add a unique contribution and differ, in some cases, from the existing literature.…”

Section: Discussionsupporting

confidence: 92%

“…The rates of off-label antipsychotic prescribing vary throughout the world, but in some settings, the rates of off-label prescribing exceed the “on” label prescribing. For example, Graziul et al analysed 781 million prescriptions of psychotropic drugs in the US, and they found the overall average off-label utilization rate of second-generation antipsychotics (SGAs) was 60.7% [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey

et al. 2021

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Background The off-label use of antipsychotic medications is common in many countries, and the extent of such use in psychiatric inpatients in China has not been sufficiently studied. The purpose of this study was to survey the incidence and examine the correlates of off-label antipsychotic use in a large, nationally–representative sample in China. Methods This study included discharged psychiatric patients between March 19 and 31, 2019 from 41 tertiary psychiatric hospitals across 29 provinces in China. Their socio-demographic and clinical data were collected and analyzed. Results After excluding patients with schizophrenia spectrum disorder or bipolar disorder, 981 patients were included in the analysis. Overall, antipsychotics were prescribed to 63.2% (95%CI 60.2–66.2%) of the sample. Antipsychotics were used in a wide spectrum of psychiatric disorders, with the rate being the highest among patients with dissociative (conversion) disorders (89.9, 95%CI 83.0–94.8%), organic mental disorders (81.7, 95%CI 73.1–88.7%), dementia (79.0,95%CI 67.8–87.9%), obsessive-compulsive disorder (77.8, 95%CI 55.7–92.5%), mental disorders due to psychoactive substances (75.3,95%CI 64.7–84.2%), behavioural and emotional disorders with onset usually occurring in childhood and adolescence (71.4, 95%CI 45.5–90.1%), somatoform disorders (63.2, 95%CI 40.8%–82..2%), major depression disorder (53.7,95%CI 48.8–58.6%), anxiety disorder (38.8,95%CI 30.5–47.7%), and insomnia (25.0, 95%CI 8.5–28.9%). The top three most commonly used antipsychotics were olanzapine (29.1%), quetiapine (20.3%) and risperidone (6.8%), and their corresponding average doses were 9.04 ± 5.80 mg/day, 185.13 ± 174.72 mg/day, and 2.98 ± 1.71 mg/day, respectively. A binary logistic regression showed that younger age, having the Employee Health Insurance or Residents Health Insurance, having psychotic symptoms and requiring restraint during hospitalization were significantly associated with off-label use of antipsychotics. Conclusion Off-label use of antipsychotics is very common in psychiatric inpatients in China, mainly with moderate-dose use of single agents. However, the efficacy and safety of this practice is uncertain for many diagnoses and for the elderly. Clinicians should be cautious about this practice while waiting for more research data.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey

et al. 2021

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References

2014

Off‐label Prescribing – Justifying Unapproved Medicine

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Hospital pharmacists’ perceived beliefs and responsibilities in indication-based off-label prescribing

Basak

McCaffrey

2017

Int J Clin Pharm

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Background Off-label prescribing is prevalent in healthcare. There is a lack of understanding of pharmacists' attitudes toward the practice of off-label prescribing, especially those that are prescribed for other indications than approved ones (termed as indication-based off-label prescribing). Objective Explore hospital pharmacists' attitudes toward and perceived responsibility in off-label and indication-based off-label prescribing in hospital pharmacy practice. Setting Pharmacists practicing in hospitals in the United States were investigated. Method Pharmacists were contacted via email through State affiliates of the American Society of Health-System Pharmacist. The survey described an indication-based off-label medication order for a hospitalized patient and the prescribing physician. Data were collected via Qualtrics. Main outcome measure Questions focused on awareness, beliefs, and responsibility-including, risk assessment and monitoring outcomes-related to off-label and indication-based offlabel prescribing. Results Of 107 pharmacist respondents, about 79% and 98% reported being familiar with offlabel and indication-based off-label prescribing, respectively. While 77.6% pharmacists believed that patients should be informed, only 37.4% agreed that they had responsibility of informing physicians; presence of policy was associated (p < 0.02) with pharmacist agreeing to inform physicians. Over 70% agreed that patients should be closely monitored for outcomes and 43.1% believed physicians had predominant responsibility of monitoring outcomes. Conclusion Pharmacists' perceived responsibility and beliefs regarding off-label prescribing are insightful that can be utilized for improving patient care.

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Association Between the Commercial Characteristics of Psychotropic Drugs and Their Off-label Use

Abstract: Our findings suggest that drug prescription volume, rather than product age or therapeutic class age, should be scrutinized further to identify settings where the public health impact of unsupported off-label prescribing may be particularly important.

Cited by 9 publications

References 22 publications

Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey

Off-label use of antipsychotic medications in psychiatric inpatients in China: a national real-world survey

References

Hospital pharmacists’ perceived beliefs and responsibilities in indication-based off-label prescribing

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